Telemental Health Now Serves 1 in 4 Outpatients

Telehealth has rapidly reshaped outpatient mental health care in the US, with new data showing that nearly 28% of adult mental health outpatients relied exclusively on virtual visits in 2021–2022.¹ A national survey of adults reveals striking differences in who uses telehealth, who prefers in-person care, and how treatment type influences these choices—highlighting both the promise of digital access and the inequalities that remain.

This cross-sectional analysis is published in JAMA Psychiatry.

“Greater reliance of higher socioeconomic groups on telemental health suggests that they use their stronger financial position and other resources to receive remote care,” wrote the researchers of the study. “Higher socioeconomic patients, including employed individuals and those with higher incomes, appear to favor telemental health over in-person care, as they were less likely to use in-person services compared to their unemployed and lower-income counterparts, even though they presumably had a choice of treatment modality.”

Virtual mental health care has become not just a pandemic stopgap but a valuable, enduring option for many patients.² Telehealth makes care more accessible, allowing patients to join sessions from home, during a break, or from their car, eliminating transportation and scheduling barriers. Although some clinicians emphasize that in-person care remains essential for certain evaluations or crises, many see telehealth as a permanent complement to traditional therapy, greatly expanding access.

The study examined how US adults utilized telemental health, hybrid, and in-person outpatient mental health services.¹ Researchers analyzed data from the 2021–2022 Medical Expenditure Panel Survey, focusing on 4720 adults aged 18 years or older who reported receiving mental health care. They calculated average annual percentages of patients using each care modality and stratified results by sociodemographic and clinical characteristics.

Differences across subgroups—such as age, education, income, insurance, urban vs rural residence, psychological distress level, treatment type, and clinician type—were assessed using models adjusted for age, sex, and distress (Kessler-6 scale).

The primary exposure was the type of mental health care received: all telemental health, hybrid, or all in-person. This approach enabled the researchers to characterize national use patterns and identify which groups were more or less likely to rely on telehealth-based care.

Among adults surveyed, 27.8% (95% CI, 25.7-29.8) received all telemental health care, 21.5% (95% CI, 19.8-23.1) received hybrid care, and 50.6% (95% CI, 48.2-53.1) received all in-person care.

Telehealth use was highest among adults aged 18 to 44 years (31.7%; 95% CI, 29.0%-34.3%), college graduates (34.5%; 95% CI, 31.5%-37.5%), higher-income patients (33.8%; 95% CI, 30.9%-36.7%), private insurance holders (30.8%; 95% CI, 28.5%-33.1%), and urban residents (29.2%; 95% CI, 27.0%-31.3%).

Psychotherapy users—without medication (41.6%; 95% CI, 38.0%-45.2%) or with medication (25.9%; 95% CI, 23.2%-28.6%)—and those with less than moderate distress (29.2%; 95% CI, 26.1%-32.3%) were also more likely to use telehealth, whereas patients receiving only medication or treated by counselors (10.9%; 95% CI, 7.0%-14.7%) or social workers (8.4%; 95% CI, 4.1%-12.7%) used it less.

However, the researchers acknowledged several limitations. First, the survey relied on self-reported data, which may have underestimated mental health care use, and K6 scores were not diagnostic. Second, statistical adjustments for multiple comparisons were not made, and small sample sizes required combining telehealth types. Nonresponse may have also introduced bias despite weighting adjustments, and COVID-19 likely affected 2021–2022 treatment patterns. Finally, the survey did not allow assessment of clinical effectiveness.

Despite these limitations, the researchers believe this study highlights that telemental health has become a widely used option for outpatient mental health care in the US, particularly among younger, higher-income, college-educated, and urban patients, as well as those receiving psychotherapy and experiencing less severe distress.

“For the foreseeable future, telemental health care is likely to remain a major modality for delivering outpatient mental health care in the US,” wrote the researchers. “The findings of this study indicating an unequal distribution of telemental health care use across income, education, employment, insurance, and geographic groups as well as treating clinicians, mental health conditions, and treatments may suggest socioeconomic and geographic barriers to this means of delivering outpatient mental health care.”

References

1. Olfson M, McClellan C, Zuvekas SH, Blanco C. Telemental health, hybrid, and in-person outpatient mental health care in the US. JAMA Psychiatry. Published online November 26, 2025. Accessed November 24, 2025. doi:10.1001/jamapsychiatry.2025.3575

2. Macmillan C. Why telehealth for mental health care is working. Yale Medicine. September 16, 2021. Accessed November 24, 2025. https://www.yalemedicine.org/news/telehealth-for-mental-health